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SHAKAMAK HEALTH INC
FQHCLA351E GREENE COUNTY HEALTH, INC.
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Covered Entity Details
Entity Name
GREENE COUNTY HEALTH, INC.
Subdivision Name
Greene County Health - Linton
Type
Health Center Program Look-Alike
340B ID
FQHCLA351E
Entity Address
1600 A Street NE
Suite 9
Linton, IN 47441
Grant Number
LALCS31107
Participating Start Date
10/1/2017
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
SHAKAMAK HEALTH INC
Pharmacy Address
D/B/A SHAKAMAK PHARMACY
346 E MAIN ST
JASONVILLE, IN 47438
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Corianne Vanderkolk, CEO
(812) 699-4153
Contract Pharmacy Representative
shakamak pharmacy
traver lee wolf, owner
(812) 665-9760
Signed By Date
10/11/2019
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